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1.
Nutritional Management for Chronic Kidney Disease Patients who Undergo Bariatric Surgery: A Narrative Review.
Ben-Porat, T, Weiss-Sadan, A, Rottenstreich, A, Sherf-Dagan, S, Schweiger, C, Yosef-Levi, IM, Weiner, D, Azulay, O, Sakran, N, Harari, R, et al
Advances in nutrition (Bethesda, Md.). 2019;(1):122-132
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Abstract
Bariatric surgery (BS) may be effective for chronic kidney disease (CKD) patients by reducing microalbuminuria and proteinuria, and by facilitating their meeting inclusion criteria for kidney transplantation. However, nutritional management for this population is complex and specific guidelines are scarce. A literature search was performed to create dietetic practice for these patients based on the most recent evidence. For the purposes of nutritional recommendations, we divided the patients into 2 subgroups: 1) patients with CKD and dialysis, and 2) patients after kidney transplantation. Before surgery, nutritional care includes nutritional status evaluation and adjusting doses of supplements to treat deficiencies and daily nutrient intake according to the dietary restrictions derived from kidney disease, including quantities of fluids, protein, phosphorus, potassium, and vitamins. After BS, these patients are at major risk for lean body mass loss, malnutrition and dehydration because of fluid restriction and diuretics. Postoperative nutritional recommendations should be carefully tailored according to CKD nutritional limitations and include specific considerations regarding protein, fluids, and supplementation, in particular calcium, vitamin A, and vitamin D. Nutritional management of CKD and kidney transplant patients undergoing BS is challenging and future studies are required to establish uniform high-level evidence-based guidelines.
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Impact of bariatric surgery on type 2 diabetes: contribution of inflammation and gut microbiome?
Debédat, J, Amouyal, C, Aron-Wisnewsky, J, Clément, K
Seminars in immunopathology. 2019;(4):461-475
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Abstract
Obesity is a chronic low-grade inflammatory disease (both at the systemic and adipose tissue level) that continues to rise worldwide. It is associated with an abundance of comorbidities, including type 2 diabetes (T2D). Bariatric surgery, which induces modifications of the intestinal tract, is to date the most successful treatment for obesity. Its use has dramatically increased in number as it enables both weight reduction and metabolic improvements, with 60% of patients even achieving diabetes remission. Several mechanisms are actually demonstrated to be involved in those clinical improvements. Importantly, both obesity and T2D share many phenotypic characteristics, including increased systemic and adipose tissue inflammation, as well as gut microbiota dysbiosis. These characteristics are deeply modulated after bariatric surgery. This review will address the host metabolic changes observed after bariatric surgery, focusing on the induced gut architectural changes, as well as on the modifications of the inflammatory tone and the gut microbiota.
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Psychosocial Concerns Following Bariatric Surgery: Current Status.
Kalarchian, MA, Marcus, MD
Current obesity reports. 2019;(1):1-9
Abstract
PURPOSE OF REVIEW The purpose of this paper is to review the current status of research on psychosocial concerns following bariatric surgery. RECENT FINDINGS Bariatric surgery has a positive overall impact on weight and obesity-related comorbidities, as well as a positive short-term impact on mental health and psychosocial functioning. Nonetheless, research has documented a number of different psychosocial concerns that may emerge following surgery including maladaptive eating, substance use disorders, suicide, lack of social support, and excess skin. Moreover, special populations of patients may have distinctive psychosocial concerns based on sociodemographic factors such as age or severity of obesity. Available studies suggest that psychosocial interventions have a positive impact on post-surgery outcomes, particularly maladaptive eating. However, research is limited, and long-term data are lacking. Monitoring patients after bariatric surgery for negative psychosocial outcomes is warranted. Research is needed to develop and evaluate personalized approaches to optimize long-term weight loss and psychosocial adjustment.
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Precision Medicine in Weight Loss and Healthy Living.
Severin, R, Sabbahi, A, Mahmoud, AM, Arena, R, Phillips, SA
Progress in cardiovascular diseases. 2019;(1):15-20
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Abstract
Obesity affects 600 million people globally and over one third of the American population. Along with associated comorbidities, including cardiovascular disease, stroke, diabetes, and cancer; the direct and indirect costs of managing obesity are 21% of the total medical costs. These factors shed light on why developing effective and pragmatic strategies to reduce body weight in obese individuals is a major public health concern. An estimated 60-70% of obese Americans attempt to lose weight each year, with only a small minority able to achieve and maintain long term weight loss. To address this issue a precision medicine approach for weight loss has been considered, which places an emphasis on sustainability and real-world application to individualized therapy. In this article we review weight loss interventions in the context of precision medicine and discuss the role of genetic and epigenetic factors, pharmacological interventions, lifestyle interventions, and bariatric surgery on weight loss.
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Interplay between the Adaptive Immune System and Insulin Resistance in Weight Loss Induced by Bariatric Surgery.
Villarreal-Calderón, JR, Cuéllar, RX, Ramos-González, MR, Rubio-Infante, N, Castillo, EC, Elizondo-Montemayor, L, García-Rivas, G
Oxidative medicine and cellular longevity. 2019;:3940739
Abstract
Low-grade chronic inflammation plays a pivotal role among other pathophysiological mechanisms involved in obesity. Innate and adaptive immune cells undergo systemic proinflammatory polarization that gives rise to an increased secretion of proinflammatory cytokines, which in turn leads to insulin resistance. Bariatric surgery is currently the most effective treatment for obesity, as it brings on significant weight loss, glucose metabolism improvement, and a decrease in systemic inflammation biomarkers. After bariatric surgery, several changes have been reported to occur in adaptive immunity, including reduction in CD4+ and CD8+ T cell counts, a decrease in the Th1/Th2 ratio, an increase in B regulatory cells, and reduction in proinflammatory cytokine secretion. Overall, there seems to be a major shift in several lymphocyte populations from a proinflammatory to an anti-inflammatory phenotype. Furthermore, increased antioxidant activity and reduced lipid and DNA oxidation products have been reported after bariatric surgery in circulating mononuclear cells. This paper highlights the shift in the adaptive immune system in response to weight loss and improved insulin sensitivity, as well as the interplay between immunological and metabolic adaptations as a result of bariatric surgery. Finally, based on data from research, we propose several mechanisms such as changes in adaptive immune cell phenotypes and their by-products, recruitment in adipose tissue, reduced oxidative stress, and modification in metabolic substrate availability as drivers to reduce low-grade chronic inflammation after bariatric surgery in severe obesity.
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Metabolic surgery and iron homeostasis.
Benotti, PN, Wood, GC, Still, CD, Gerhard, GS, Rolston, DD, Bistrian, BR
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2019;(4):612-620
Abstract
Iron deficiency and anaemia after metabolic surgery, potentially modifiable nutritional complications, are becoming an increasing cause for concern as prevalence increases with time and there is limited evidence supporting the effectiveness of the current guidelines for prophylactic oral iron supplementation and treatment for deficiency. Abnormalities in iron nutrition predisposing to deficiency are common in severely obese patients, and the low-grade systemic inflammation, also common to these patients, reduces the effectiveness of oral iron supplementation. The surgical procedures result in alterations of foregut anatomy and physiology, which limit iron absorptive capacity and daily food intake. These alterations and the limited effects of oral iron supplementation explain the high prevalence of postoperative iron deficiency and anaemia. This review outlines current mechanisms concerning the pathogenesis of disordered iron nutrition in patients with severe obesity, current gaps in knowledge, and opportunities for quality improvement.
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The pros and cons of gastric bypass surgery - The role of the Roux-limb.
Björklund, P, Fändriks, L
Best practice & research. Clinical gastroenterology. 2019;:101638
Abstract
The prevalence of overweight and obesity has exploded in the post-industrial era. Life style interventions like dieting and exercise can induce a marked weight loss, but the main problem for most patients is to maintain the reduced body weight over time. Gastric bypass surgery is a commonly performed and very effective method for achieving a pronounced and sustained weight loss including metabolic improvements in obese patients. Despite the therapeutic successfulness there are known side-effects like chronic postprandial nausea and pain that in some patients become intractable. The pathophysiology is complex and partly unexplored. The physician or surgeon handling a patient with "post-bariatric symptoms" must be aware of the risk for symptom aggravations due to iatrogenic opioid-associated intestinal dysmotility. The present paper gives a brief overview of obesity surgery and its associated postsurgical conditions with a focus on the unexplored role of the Roux-limb following gastric bypass surgery.
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[Psychological assessment of candidates for bariatric surgery].
Tisljár-Szabó, E, Tisljár, R
Orvosi hetilap. 2019;(12):448-455
Abstract
Nowadays, the number of bariatric surgery for treating morbid obesity is significant. There is strong evidence about the influence of mental state (depression, anxiety, eating disorder, etc.) on patient's cooperation with the medical team and the outcome, and on the short or long-term effectiveness of surgery. However, no protocol or recommendation exist for screening patients before bariatric procedures in Hungary. Thus, even if the surgeon or the hospital requires psychological expertise, neither doctors are familiar with the expectable results of such an expertise, nor psychologists know exactly what the most important areas are to talk through with patients. This article shortly reviews the mostly used bariatric surgery procedures and presents a protocol that was developed by the Ochsner Clinic, New Orleans in detail. Based on the protocol, the core parts of the psychological interview are the following: reasons for seeking surgery (I.), weight and diet history (II.), current eating behaviors (III.), understanding of the surgery and its associated lifestyle changes (IV.), social supports (V.), and history and psychiatric symptoms (current and past) (VI.). The original protocol was completed with newer, more recent studies, statements, and with examples by the authors. Orv Hetil. 2019; 160(12): 448-455.
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Impact of bariatric surgery on bone tissue.
Botella Martínez, S, Petrina Jauregui, E, Escalada San Martín, J
Endocrinologia, diabetes y nutricion. 2019;(1):62-68
Abstract
The important prevalence and morbidity of obesity has generated an increase in bariatric surgery. It has a positive effect in obesity-related comorbidities. However, it's detrimental to bone health. The underline pathophysiological mechanisms are complex and heterogeneous. The knowledge of these factors may lead us to develop an adequate therapeutic intervention.
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Obesity.
Tsai, AG, Bessesen, DH
Annals of internal medicine. 2019;(5):ITC33-ITC48
Abstract
The role of internists in evaluating obesity is to assess the burden of weight-related disease, mitigate secondary causes of weight gain (medications, sleep deprivation), and solicit patient motivation for weight loss. Internists should assess these factors and emphasize the importance of weight loss for the individual patient. All patients wishing to lose weight should be encouraged to monitor their diet and physical activity and should be referred to high-intensity behavioral programs. Some patients with obesity may also benefit from pharmacotherapy or bariatric surgery.